Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans

Authors

  • Alfredo J. Selim,

    1. Center for Health Quality, Outcomes & Economic Research, Edith Nourse Rogers Memorial Hospital (152), Building 70, 200 Springs Road, Bedford, MA 01730
    2. Emergency Services, Boston VA Health Care System, West Roxbury campus, West Roxbury, MA
    3. Boston University School of Medicine, Boston, MA
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    • Address correspondence to Alfredo J. Selim, M.D., M.P.H., Center for Health Quality, Outcomes & Economic Research, Edith Nourse Rogers Memorial Hospital (152), Building 70, 200 Springs Road, Bedford, MA 01730; e-mail: alfredo.selim2@va.gov. Alfredo J. Selim, M.D., M.P.H., is also Physician with the Emergency Services, Boston VA Health Care System, West Roxbury campus, West Roxbury, MA, and also Assistant Professor of Medicine with the Boston University School of Medicine, Boston, MA. Dan Berlowitz, M.D. M.P.H., is with the Center for Health Quality, Outcomes & Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA. Lewis E. Kazis, Sc.D., Senior Scientist, Shirley X. Qian M.S., SAS Programmer, James A. Rothendler, M.D., Medical Officer, Avron Spiro III, Ph.D., Senior Research Scientist, and Donald Miller, Sc.D., Senior Research Scientist, are with the Department of Veteran Affairs Medical Center, Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA. Lewis E. Kazis, Sc.D., Associate Professor of Health Services, James A. Rothendler, M.D., M.P.H, Assistant Professor of Health Policy and Management, Avron Spiro III, Ph.D, and Donald Miller, Sc.D, Associate Professor of Epidemiology, are also with the Boston University School of Public Health, Boston, MA. William Rogers, Ph.D., is Senior Statistician with The Health Institute, New England Medical Center, Tufts-New England Medical Center, Boston, MA. Steven M. Wright, Ph.D., is Director of Epidemiology for the Office of Quality and Performance, Office of Quality and Performance, U.S. Department of Veterans Affairs, Washington, DC. Bernardo J. Selim, M.D., is Physician with the Yale-New Haven Hospital, New Haven, CT. Benjamin G. Fincke, M.D., is Physician with the Department of Veterans Affairs Medical Center, Patient Care Services, Medical Service, Center for Health Quality, Outcomes & Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA, and also Associate Professor of Medicine with the Boston University School of Medicine, Boston, MA.

  • Dan Berlowitz,

    1. Center for Health Quality, Outcomes & Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA
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  • Lewis E. Kazis,

    1. Department of Veteran Affairs Medical Center, Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA
    2. Boston University School of Public Health, Boston, MA
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  • William Rogers,

    1. The Health Institute, New England Medical Center, Tufts-New England Medical Center, Boston, MA
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  • Steven M. Wright,

    1. U.S. Department of Veterans Affairs, Washington, DC
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  • Shirley X. Qian,

    1. Department of Veteran Affairs Medical Center, Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA
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  • James A. Rothendler,

    1. Department of Veteran Affairs Medical Center, Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA
    2. Boston University School of Public Health, Boston, MA
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  • Avron Spiro III,

    1. Department of Veteran Affairs Medical Center, Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA
    2. Boston University School of Public Health, Boston, MA
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  • Donald Miller,

    1. Department of Veteran Affairs Medical Center, Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA
    2. Boston University School of Public Health, Boston, MA
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  • Bernardo J. Selim,

    1. Yale-New Haven Hospital, New Haven, CT
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  • Benjamin G. Fincke

    1. Boston University School of Medicine, Boston, MA
    2. Department of Veterans Affairs Medical Center, Patient Care Services, Medical Service, Center for Health Quality, Outcomes & Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA
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Abstract

Objectives. To compare the Veterans Health Administration (VHA) with the Medicare Advantage (MA) plans with regard to health outcomes.

Data Sources. The Medicare Health Outcome Survey, the 1999 Large Health Survey of Veteran Enrollees, and the Ambulatory Care Survey of Healthcare Experiences of Patients (Fiscal Years 2002 and 2003).

Study Design. A retrospective study.

Extraction Methods. Men 65+ receiving care in MA (N=198,421) or in VHA (N=360,316). We compared the risk-adjusted probability of being alive with the same or better physical (PCS) and mental (MCS) health at 2-years follow-up. We computed hazard ratio (HR) for 2-year mortality.

Principal Findings. Veterans had a higher adjusted probability of being alive with the same or better PCS compared with MA participants (VHA 69.2 versus MA 63.6 percent, p<.001). VHA patients had a higher adjusted probability than MA patients of being alive with the same or better MCS (76.1 versus 69.6 percent, p<.001). The HRs for mortality in the MA were higher than in the VHA (HR, 1.26 [95 percent CI 1.23–1.29]).

Conclusions. Our findings indicate that the VHA has better patient outcomes than the private managed care plans in Medicare. The VHA's performance offers encouragement that the public sector can both finance and provide exemplary health care.

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